Provider Demographics
NPI:1184841439
Name:TREVINIO, LINO E (SW)
Entity type:Individual
Prefix:
First Name:LINO
Middle Name:E
Last Name:TREVINIO
Suffix:
Gender:M
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 BLUEWATER RD NW
Mailing Address - Street 2:JIMMY CARTER MS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-2024
Mailing Address - Country:US
Mailing Address - Phone:505-833-7540
Mailing Address - Fax:
Practice Address - Street 1:8901 BLUEWATER RD NW
Practice Address - Street 2:JIMMY CARTER MS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-2024
Practice Address - Country:US
Practice Address - Phone:505-833-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM 46741041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46757813Medicaid